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General NPI Number Information
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NPI Number | 1316181316
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Entity Type | Organization
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Legal Business Name | SIMON MELNICK DO, LTD
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 1050 MAIN ST UNIT 8
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City | EAST GREENWICH
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State | RI
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Zip | 02818-3162
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Country | US
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Telephone | 401-886-7030
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Fax | 401-886-7031
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Provider Business Mailing Address
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Address Line | 60 FALCON CIR
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1307
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Country | US
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Telephone | 401-886-7030
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Fax | 401-886-7031
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Authorized Official
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Title or Position | OWNER
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Name | SIMON MELNICK
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Credential | DO
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Telephone | 401-886-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | DO00518
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License Number State | RI
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